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J Thorac Cardiovasc Surg 2003;126:1314-1319
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Skeletonization of bilateral internal thoracic artery grafts lowers the risk of sternal infection in patients with diabetes

^a Division of Cardiac Surgery, Toronto General Hospital, Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Received for publication January 13, 2003; revisions received March 6, 2003; revisions received April 7, 2003; accepted for publication May 16, 2003.

^* Address for reprints: Michael A. Borger, MD, PhD, Division of Cardiac Surgery, Toronto General Hospital EN 13-217, 200 Elizabeth Street, Toronto, Ontario, Canada, M5G 2C4
michael.borger{at}uhn.on.ca

OBJECTIVE: Deep sternal wound infection is a dreaded complication of coronary artery bypass surgery, particularly in patients with diabetes. This study determines whether skeletonization of internal thoracic artery conduits compared with pedicled harvesting reduces the risk of deep sternal wound infection in patients with diabetes undergoing bilateral internal thoracic artery grafting.

METHODS: We reviewed prospectively gathered data on all patients who have undergone coronary artery bypass grafting and received bilateral internal thoracic artery grafts at our institution since 1990. We compared patients with diabetes who received skeletonized (n = 79) versus conventional pedicled (n = 36) internal thoracic artery conduits.

RESULTS: The proportion of patients taking insulin (19.0% vs 14.0% for skeletonized vs conventional grafts, respectively, P = .6) or oral hypoglycemic agents (68.4% vs 69.4%, P = .9), as well as the prevalence of type I diabetes (2.5% vs 8.3%, P = .18), were similar in both groups. Patients who received skeletonized grafts were more likely to receive a free rather than an in situ right internal thoracic artery graft (93.7% vs 30.6%, P < .001). The prevalence of deep sternal wound infection was significantly lower in patients who received skeletonized grafts compared with patients who received conventional grafts (1.3% vs 11.1%, P = .03). Patients in the skeletonized group were also less likely to develop any (superficial or deep) sternal wound infection postoperatively (5.1% vs 22.2%, P = .03). There was no significant difference in the prevalence of deep sternal wound infection between patients with diabetes who received skeletonized internal thoracic arteries and patients without diabetes who underwent conventional internal thoracic artery grafting (n = 578) (1.2% vs 1.6%, respectively, P = .8).

CONCLUSIONS: Skeletonization of internal thoracic artery conduits lowers the risk of deep sternal wound infection in patients with diabetes undergoing bilateral internal thoracic artery grafting. We no longer consider diabetes a contraindication to bilateral internal thoracic artery grafting, provided the internal thoracic arteries are skeletonized.